TAFT-HARTLEY
Strengthening your Fund: to protect families, businesses and plan offerings.
Consultative Philosophy/Approach: Our consultative approach is rooted in two foundational components: Being educational and informative so clients can make well-founded decisions, and following a strategic and active approach to plan management.
Educated and Informed Trustees Enable High Performing Plans
Informing & Educating Clients
Are You Currently Receiving the Information You Need To Manage Your Plan
QUESTIONS TO ASK
Yourself and Broker
ASK YOURSELF:
- Do I feel informed and educated on our offerings?
- Do I know the current financial health of our offerings?
- Do I understand the cost drivers and market conditions driving our plan costs
- Do I feel empowered to make informed decisions?
- Am I presented options and am educated on those options to a degree to which I feel comfortable making an informed decision?
- Am I being advised on strategies to control costs and improve member benefits?
- Does my current broker measure and present results of past recommended strategies/decisions?
ASK YOUR BROKER/ACTUARY:
- Can you provide detailed information regarding the current and continued health/performance of our plan?
- Have you brought solutions to help control costs & improve benefits?
- Will you measure and report to us on the impact of your consultation/recommendations/strategic approach?
Annual
Service Plan
1st
General Update / Compliance
2nd
Strategy / Pre-Renewal
3rd
Renewal / Data Informed Decisions
4th
Implementation, Document Review, Open Enrollment Support
STRATEGIC, ACTIVE PLAN MANAGEMENT
Plan
Components
FUNDING
Impact – Year 1 of Change
Plan Funding
Reserve Utilization
STRUCTURAL
Impact – Year 1 of Change
Network
Stop Loss Coverage
- Specific Deductible
- Lasers
- Aggregate SL?
- Contract terms
Plan Administration
- UM/CM/DM/UR
- Payment accuracy
PBM
- Contract terms
- Pricing
Budgeting
PLAN SET-UP
Impact – Longer Term, Future Spend Mitigation
Plan Design:
Deductible/Out of Pocket, Max/Coinsurance
- Less efficient means of “savings”
Other Options
- Value Base Plan Design,
- Narrow Network,
- Incent COE, Near-site Clinic
- Clinic Arrangements with Local Providers
- Direct Contracts
- Etc
PLAN SET-UP:
SAMPLE MED/RX PLAN STRATEGIES
(Not an exhaustive list)
COST
STRUCTURAL: Year 1 impact, ongoing
Reference Based Pricing
Tiered & Narrow
Networks
Direct
Contracting
Unbundled Plan Administration
Cost
Transparency
CARE
RIGHT SERVICE, RIGHT PLACE: Future impact, ongoing
Onsite/Near site
Clinic
Condition
Management
Centers of
Excellence
Health Risk
Management
Plan
Design
EFFICIENCY
CONDITION MANAGEMENT: Future impact, ongoing
Pharmacy Management
Site of Service Differentials
Value Based Plan Design
Transparency Incentives
Patient
Advocacy
Proven Results
CASE STUDY –
PEPM MED/RX CLAIMS
~400 Member Taft Hartley Fund. Plan facing insolvency when IMA Was hired.
CASE
STUDY – 400EE
| Incremental Strategies, Ongoing Savings | First 2 Years Savings/Cost Avoidance: | |
|---|---|---|
| structural | PHARMACY OPTIMIZATION | $160,882 |
| RISK MANAGEMENT – SPECIFIC STOP LOSS | $78,000 | |
| PLA SET-UP | POPULATION MANAGEMENT | $725,000 |
| ANCILLARY MANGEMENT | $185,000 |